Ice grading icans 2. ASTCT ICANS Consensus Grading Neurotoxicity domain Grade 1 Grade 2 Grade 3 Grade 4 ICE score 7-9 3-6 0-2 or awake with global aphasia Unrousable Consciousness† Awakens spontaneously Awakens to voice Severity Grading for ICANS in Adults* Neurotoxicity Domain Grade 1 Grade 2 Grade 3 Grade 4 . Die pathophysiologische Ursache von ICANS ist nicht vollständig geklärt. N/A indicates not applicable. Tabelle 7: ASTCT ICANS Consensus Grading ICANS Grad 1. 6% fatal). CRS. Meist tritt ICANS vier bis fünf Tage nach CAR-T-Zell-Gabe auf , allerdings ist auch ein verzögertes Auftreten vier bis fünf Wochen nach der CAR-T-Zell-Gabe beschrieben worden . ICANS Grad 2. 9% grade 1, 2. 7 %) of cycle 1 infusions. Mit dem „Immune Effector Cell Encephalopathy“(ICE)-Scoring kann die Schwere des ICANS bestimmt werden, indem man die Punkte für folgende Faktoren aufaddiert: HHV-6B infection requires immediate initiation of antiviral therapy, while CRS/ICANS can be successfully improved with interleukin (IL)-6 receptor inhibitors and corticosteroids. Both CRS and ICANS are graded 1 through 4 and overall grade is determined by the worst parameter. This difference, however, did not ICANS grading incorporates the ICE scores, and grading ranges from mild to severe neuro-toxicity. nicht erweckbar; keine Fähigkeit zur Testdurchführung) Bewusstseins-Störung. , infection, malignancy, stroke, or hemorrhage • EEG, neuroimaging, lumbar puncture (LP) Such patients are recommended to remain within 1 h of the treatment centre for the first 28 days after CAR-T treatment, with continuous presence of a caregiver who is trained in the recognition of symptoms including ICANS . ICE score 7 to 9 3 to 6 0 to 2 0 (patient is unrousable and unable to do Chimeric antigen receptor (CAR) T cell therapy is rapidly emerging as one of the most promising therapies for hematologic malignancies. Ethics approval and consent to participate Nov 1, 2021 · The ICANS grading system incorporates the 10-point Immune Effector Cell–Associated Encephalopathy (ICE) score, a standardized assessment for encephalopathy, and evaluation of other neurologic domains including level of consciousness, severe motor weakness, seizures, and signs of elevated intracranial pressure or cerebral edema. This score is then integrated into an overall assessment of neurological function incorporating ICEスコア0の患者は、全失語で覚醒している場合はGrade 3のICANSに分類されるが、覚醒不能な場合はGrade 4のICANSに分類する。 意識レベルの低下が他の原因によるものではない（例：鎮静剤投与）。 Apr 1, 2022 · Entre ellas cabe destacar el síndrome de liberación de citoquinas y el síndrome de toxicidad neurológica asociado a la terapia con células inmunoefectoras (Immune-effector cell associated neurotoxicity syndrome conocido como ICANS), siendo este último el objetivo de nuestra revisión. A clinical challenge is that ICANS can occur several weeks after tarlatamab infusion and may occur concurrently with or independent of CRS. Rapidly evolving cerebral edema and death from cerebral toxicity have been seen with anti-CD19 CAR T-cell and it was first described in the ROCKET study (JCAR015) where five patients developed fatal cerebral edema and death, which lead closure of the trial. The severity of ICANS can be graded according to a a number of systems developed most frequently that proposed by the American Society for Transplantation and Cellular Therapy (ASTCT) 4. A modified version of CARTOX-10 (the Immune effector Cell-associated Encephalopathy (ICE) score) was incorporated into the ASTCT consensus ICANS grading system to improve the objectivity of neurotoxicity grading. 66]) and excellent &rs\uljkw 7kh 8qlyhuvlw\ ri 7h[dv 0' $qghuvrq &dqfhu &hqwhu)ru 2xwsdwlhqwv 3dwlhqw 0rqlwrulqj $iwhu ,(& lqixvlrq xqohvv rwkhuzlvh vshflilhg e\ d uhvhdufk surwrfro The symptoms are graded according to the ASBMT consensus grading 83 Immune Effector Cell-Associated Encephalopathy (ICE) score, is a nonvalidated neurological scoring system to easily asses the recommendations regarding need for more frequent ICANS assessment See below treatment chart for grading of ICANS in patients receiving bispecifics Neurotoxicity Domain Grade 1 Grade 2 Grade 3 Grade 4 ICE Scoreb 7-9 3-6 0-2 0 (patient is unarousable and unable to perform ICE) Depressed level of consciousnesssc Awakens spontaneously Awakens to voice Feb 11, 2025 · Background Immune effector cell-associated neurotoxicity syndrome (ICANS) is a common complication of chimeric antigen receptor (CAR) T-cell therapy. Any patient with an ICE score less than 2 or with seizures is classified as severe (grade 3 or 4) and should be transferred to intensive care. 1B). It has previously been referred to as ASTCT definition of ICANS (IEC-Associated Neurotoxicity Syndrome) • ICANS is “a disorder characterized by a pathologic process involving the central nervous system following any immune therapy that results in the activation or engagement of endogenous or infused T cells and/or other immune effector cells. o E. ASTCT ICANS Consensus Grading Neurotoxicity domain Grade 1 Grade 2 Grade 3 Grade 4 ICE score 7-9 3-6 0-2 or awake with global aphasia Unrousable Consciousness† Awakens spontaneously Awakens to voice and elevation in intracerebral pressure/cerebral oedema to obtain an ICANS grade. Mar 8, 2021 · In adults, the 10-point Immune Effector Cell-Associated Encephalopathy (ICE) score (Supplementary Figure 1) is used for the grading of ICANS together with other neurologic domains, such as level of consciousness, motor symptoms, seizures, and signs of elevated ICP/cerebral edema . ICANS is graded according to American Society for Transplantation and Cellular Therapy (ASTCT) grading system12 (Table 2): Table 2. e. ICANS will typically manifest within 2-3 days of the onset of CRS. Date Time Orientation4 Naming3 Following commands 1 Writing 1 Attention1 Total score /10 Handwriting assessment Date Time Patient handwriting sample ICANS grading Date Time ICANS Grade 1 - 4 Assessors signature life-threatening neurologic toxicity, including ICANS. Sep 17, 2024 · Healthcare professionals use a grading system called the immune effector cell-associated encephalopathy (ICE) score, which ranges from 1 through 4, to describe the extent of a person’s ICANS Nov 10, 2018 · ICANS grade is determined by the most severe event (ICE score, level of consciousness, seizure, motor findings, raised ICP/cerebral edema) not attributable to any other cause; for example, a patient with an ICE score of 3 who has a generalized seizure is classified as grade 3 ICANS. Nov 21, 2022 · We developed the Visual EEG-ICANS (VE-ICANS) grading scale, a grading scale with a physiological basis that has a strong correlation to ICANS severity (R = 0. Score of 10-no impairment; score of 7-9-grade 1 ICANS; score of 3-6-grade 2 May 17, 2019 · The new ASBMT consensus guidelines for grading ICANS builds on past grading schema and provides an objective, easy to apply, and more accurate way to categorize ICANS severity. Our institution lacked a standardized process for nursing assessment of ICANS via ICE scoring. The higher the ICE score is, the lower the ICANS grade. The grading system is designed for IEC therapies in clinical trials and commercial use. , directly relating adverse event to CAR T-cell therapy or not, is of high importance to avoid meaningfully affecting toxicity reporting and If the patient’s ICE score is 9 or below, notify physician immediately. Date Time Orientation4 Naming3 Following commands 1 Writing 1 Attention1 Total score /10 Handwriting assessment Date Time Patient handwriting sample ICANS grading Date Time ICANS Grade 1 - 4 Assessors signature The ICE component of the ASTCT ICANS grading scale is derived from a 10-point screening tool that enables the objective grading of overlapping encephalopathy terms. 5% grade 1, 1. Correct attribution, i. Standardized reporting through the Center for International Blood and Marrow Transplant Research will meet commercial Risk Evaluation and Mitigation Strategies requirements. g. 2 ICANS grading is determined by the most severe events3 Clinical signs and symptoms of ICANS may include but are not limited to confusional state, depressed level of Nov 9, 2024 · ICANSの重症度判定基準とは？ICANSについてCAR-T細胞療法を含むT細胞を利用する特定の免疫療法によって発現する可能性のある神経系事象のこと｡ Immune effector Cell-Associated Neurotoxicity Syndrome (ICANS : 免疫エフェクター細胞関連神経毒性症候群) という名称で呼ばれる The symptoms are graded according to the ASBMT consensus grading 83 Immune Effector Cell-Associated Encephalopathy (ICE) score, is a nonvalidated neurological scoring system to easily asses the Dec 10, 2024 · What Are CRS and ICANS? CRS and ICANS wording imply their definitions. The first element assesses encephalopathy and uses a scoring tool: ICE (green box) for patients ≥12 years and CAPD (orange box) for patients <12 years of age. , immune effector cell -associated encephalopathy (ICE) score) • Work-up to rule out other etiologies. Adapted from Lee et al 21 and Traube et al 44 with permission. Two CAR T products were recently approved in the United States and Europe for the treatment ofpatients up to age 25years with relapsed or refractory B cell acute lymphoblastic leukemia and/or adults with large B cell lymphoma. Factors associated with a higher risk of ≥ grade 3 Mar 1, 2025 · ICANS was less commonly seen after day 1 (0. ICANS can present with varying degrees of neurologic changes. CRS ist dabei ein Risikofaktor für die Entwicklung eines hochgradigen ICANS (Tab. Nov 1, 2020 · ICANS grading incorporates the ICE scores, and grading ranges from mild to severe neurotoxicity. 10 Patients Feb 19, 2021 · The Immune Effector Cell-Associated Encephalopathy (ICE) score is an encephalopathy assessment tool used for grading of ICANS in patients aged >12 years, with the highest score (ten) suggesting no Apr 1, 2019 · It is important to note that the 10-point ICE screening tool is helpful for assessing patients for encephalopathy; however, the grading of ICANS requires assessment of the 10-point ICE score as well as evaluation of other neurologic domains, such as level of consciousness, motor symptoms, seizures, and signs of elevated ICP/cerebral edema Feb 21, 2020 · For ICANS, global incidence was only 5% lower by ASTCT compared with CTCAEv4. nicht erweckbar oder nur durch repetitive taktile Aug 23, 2024 · The Immune Effector Cell Encephalopathy score and keeping a close eye on patients’ symptoms are critical when monitoring for potential ICANS during lymphoma treatment. Grade 4: ICE score: 0 A consensus grading system for CRS and ICANS has been developed by experts in the field. ASTCT recommends immune effector cell-associated encephalopathy (ICE) scoring to detect ICANS in patients aged ≥12 years. 1,9,16 ICANS grading may not capture mild symptoms like headache or very mild speech alterations without frank dysphasia, leading to slight underestimation of neurotoxicity by ASTCT. 58 [0. Apr 9, 2020 · In addition to the ICE score, ICANS consensus grading also takes into account consciousness, seizures, motor findings, and cerebral edema. Grade 1: ICE score: 7 to 9 with no depressed level of consciousness. Diagnostic Assessment • ICANS grading scales (e. ICANS Grad 3. Mar 4, 2025 · Assessments using the immune effector cell-associated encephalopathy (ICE) score are essential for early detection and intervention of ICANS, Miller said. Objective To demonstrate modifications to ICE score to patients with vision and hearing impairments or Nov 21, 2024 · Die Schwere des ICANS korreliert mit der Tumorlast und die Nebenwirkung kann, muss aber nicht, mit einem CRS gekoppelt sein. Pat. ‡Based on American Society for Transplantation and Cellular Therapy (ASTCT) Consensus Grading (2019). 3% grade 2, 0. 03, consistent with previously reported results. 5 %), day 8 (0. Nov 15, 2022 · ICANS grading uses the immune effector cell encephalopathy (ICE) score to measure alterations in speech, orientation, handwriting, attention, and receptive aphasia. Tools like the Immune Effector Cell Encephalopathy (ICE) score allow oncology nurses and advanced practice providers (APPs) to ICANS occurred in 6% of patients with LBCL in the clinical trial (4. This cytokine-mediated immune response is the most common toxicity with a wide range of symptoms from low-grade fever to life-threatening multi-organ involvement. Fig. In adults, the 10-point Immune Effector Cell-Associated Encephalopathy (ICE) score (Supplementary Figure 1) is used for the grading of ICANS together with other neurologic domains, such as level of consciousness, motor symptoms, seizures, and signs of elevated ICP/cerebral edema . Durch Ansprache erweckbar. We also compared our VE-ICANS model with another model (VE-CAM-S) developed to measure the severity of encephalopathy in the general hospitalized patient setting, as opposed to our VE-ICANS grading scale which is designed to specifically assess ICANS in patients who have undergone CAR-T treatment 31. If the patient’s ICE score is 9 or below, notify physician immediately. 3 Best practice recommendations for the management of ICANS following CAR T cell therapy according to the European Society for Blood and Marrow Transplantation ICANS grading according to ASTCT consensus grading scale: a. ICANS grading (blue box) has 5 elements. Although this consensus grading schema has been imperative in identifying and monitoring CRS and ICANS in our CAR T cell population, we observed patients exhibiting subtle Feb 7, 2022 · The higher the ICE score is, the lower the ICANS grade. Jul 23, 2020 · A consensus grading schema for cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) resulting from chimeric antigen receptor (CAR) T cell therapy was published in 2019. They can occur with or without the other toxicity. These scales guide treatment decisions, helping clinicians determine when to escalate supportive care or initiate targeted therapies. Regarding CRS, all grades feature a fever of 38 degrees Celsius or higher. [30]. ICANS Grad 4. , “show me 2 fingers” or “close your eyes and stick out your tongue”): 1 ICANS ist eine Ausschlussdiagnose, weshalb eine ausführliche Diagnostik ratsam ist. , point to clock, pen, button): 3 points • Following commands: Ability to follow simple commands (e. ICANS. 60 ICE is a modified version of the CARTOX-10 screening tool, and evaluates the following abilities: (1) orientation, (2) naming, (3) command following, (4) writing, and (5 • Severe CRS is associated with severe ICANS. 5 %), and day 15 (3. ICE-Score* 7-9. Aunque los mecanismos fisiopatológicos que conducen . ICANS occurred in 6% of patients with FL receiving the 2-step up dosage schedule in the clinical trial (3. Apr 26, 2025 · Grading. 15, 16 Therefore To improve grading of and surveillance for neurotoxicity the CARTOX-10 criteria, a 10-point screening tool, was developed in 2017 . Severe cases of ICANS with death have been described. The grading system is based on a modified Mini-Mental Test, combined the a number of clinical features and imaging evidence of cerebral edema 1,4 ICANS grade is determined by the most severe event (ICE score, level of consciousness, seizure, motor findings, raised ICP/cerebral oedema) not attributable to any other cause; for example, a patient with an ICE score of 3 who has a generalized seizure is classified as grade 3 ICANS. 28–30 The incidence of fatal neurotoxicity following anti-CD19 CAR T-cell therapy Nov 2, 2020 · The ICE score (Table 1) and ICANS grading system (Table 2) are the most widely used tools to detect and monitor ICANS, but in our experience may lack sensitivity in early cases. More subtle signs and symptoms of early neurotoxicity are not fully captured by the ICE score yet have been observed at our center and reported in the literature (Herr Encephalopathy screening tool-Immune Effector Cell-Associated Encephalopathy (ICE) score, adapted from Lee et al. 5 days (range: 1 to 154 days). ASTCT ICANS GRADING AND MONITORING CRS and ICANS Grading, Monitoring, & Management Orientation: date, location, age Score: 4 Naming: ability to identify 3 objects Score: 3 Commands: ability to follow simple commands Score: 1 Writing: ability to write a standard sentence Score: 1 ICE Parameter Attention: ability to count backward Score: 1 10: no CAR T-Cell Grading and Management: ICANS ICANS Grading ICANS Parameter Grade 1 Grade 2 Grade 3 Grade 4 ICE Score* 7 -9 3 – 6 0 – 2 0 Level of Consciousness Awakens spontaneously Awakens to voice Awakens to tactile stimuli Unarousable or difficult to arouse; stupor or coma Seizure -- -- < 5 minutes > 5 minutes Motor findings ICE adds a command-following assessment in place of 1 of the CARTOX-10 orientation questions. Current practice guidelines recommend the immune effector cell-associated encephalopathy (ICE) score for the assessment and monitoring of ICANS. b. We determine ICE scores on all immune effector cell therapy patients at baseline before the initiation of lymphodepletion or, if no lymphodepletion is given, then before CAR T cell infusion. 4% grade 2). 47–0. We determine ICE scores on all immune effector cell therapy patients at baseline before the initiation of lymphode-pletion or, if no lymphodepletion is given, then before CAR T cell infusion. 1 § If patient is arousable and able to perform ICE Assessment, assess: orientation (oriented to year, month, city, hospital = 4 points); naming (names 3 objects, eg, point to clock, pen, button = 3 points); following commands (eg, “show me 2 fingers” or “close your eyes and stick out ICANS is typically associated with CRS, though few patients may develop ICANS without previous or concomitant CRS, ICANS may develop after CRS symptoms have resolved ; rarely both complications can occur simultaneously . After infusion, ICE scores are administered a min- Immune effector cell-associated neurotoxicity syndrome (ICANS) is a complication of chimeric antigen receptor (CAR) T-cell therapy necessitating early identification. Spontan erweckbar. Of the 10 ICANS events, 9 occurred in cycle 1 of treatment. Factors associated with a higher risk of ≥ grade 3 ICANS include a higher disease burden, low platelet count, and the development of early and The grading of ICANS includes the ICE score as well as depressed level of consciousness, seizure activity, motor findings, and raised ICP pressure/cerebral edema (Tables 4, 5). 0 (Pat. The ICE score (Table 1) and ICANS grading system (Table 2) are the most widely used tools to detect and monitor ICANS, but Immune Effector Cell Encephalopathy (ICE) Score • Orientation: Orientation to year, month, city, hospital: 4 points • Naming: Ability to name 3 objects (e. The scoring system remains the same. The onset of ICANS can be concurrent with CRS, following resolution of CRS, or in the absence of CRS. Dec 10, 2021 · ASTCT consensus grading for ICANS. 14 It uses an updated encephalopathy screening tool, termed Immune Effector Cell Encephalopathy (ICE) score, which is similar to the CARTOX-10 but includes an element Download scientific diagram | ASTCT Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) Consensus Grading for Adults from publication: Assessing and Management of Neurotoxicity After Apr 29, 2025 · ICANS and CRS severity is classified using grading systems that assess symptom progression, medical intervention needs, and risk of long-term complications. 24 The ASTCT grading tool was created to provide a means to better assess and harmonize the classification of CAR-T cell therapy-associated NT and its treatment across diseases, regions, and CAR-T cell products. A ICANS is graded according to American Society for Transplantation and Cellular Therapy (ASTCT) grading system12 (Table 2): Table 2. The ICE score has five components: orientation, naming, following commands, writing, and attention. 3-6. Scoring: 10, no impairment; 7-9, grade 1 ICANS; 3-6, grade 2 ICANS; 0-2, grade 3 ICANS ; 0 due to patient unarousable and unable to perform ICE assessment, grade 4 ICANS. Durch taktilen Reiz erweckbar. 0-2. Diese umfasst: cCT; MRT; EEG; neurologische Untersuchung; Darüber hinaus ist der Immuneffektor-Zell-assoziierte Enzephalopathie-Score (ICE-Score) ein wichtiger Bestandteil der Diagnose des ICANS. Vor Beginn einer CAR-T-Zell-Therapie sollte deshalb ein Feb 7, 2022 · All patients should be proactively monitored for ICANS twice daily to assess subtle changes in cognition using the 10-point Immune Effector Cell Encephalopathy (ICE) score (Table 27. Any patient with an ICE score less than 2 or with seizures is classied as severe (grade 3 or 4) and should be transferred to intensive care. 1), which evaluates orientation, attention, writing, and language. Aug 31, 2021 · To standardize grading, the American Society for Transplantation and Cellular Therapy (ASTCT) set forth consensus grading criteria for CRS and ICANS. The median onset of ICANS from first dose was 29. Immune effector cell-associated neurotoxicity syndrome (ICANS) is a clinical and neuropsychiatric syndrome that can occur in the days to weeks following administration of certain types of immunotherapy, especially immune effector cell (IEC), T cell engaging, and engineered T cell receptor therapies.